Presentation
7 weeks pregnant by dates. Presents with abdominal pain and PV bleeding.
Patient Data
A 7 mm gestational sac is seen in the cervix, demonstrating sliding.
CRL: 3.0 mm (5 weeks 3 days)
YS: 3.2 mm
No embryonic cardiac motion is seen.
No perigestational hemorrhage.
There is a moderate (55 x 20 x 55 mm; 31.5ml) region of partially vascular hyperechoic material in the uterine cavity, representing a combination of retained products of conception and hemorrhage.
Case Discussion
The differential for a gestational sac in the cervical canal is either a miscarriage in progress with the gestational sac passing through the cervical canal at the time of scanning, or a cervical ectopic pregnancy.
This case favors a miscarriage in progress, based on the following features:
presentation with pain; typically, a cervical ectopic will present with painless bleeding
sliding of the gestational sac with probe pressure (see video clip)
fetal HR - absence of HR is non specific, but if one was present this would favor a cervical ectopic.
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